How much rates vary
Facilitymedian $2,512 · 10th to 90th $155 to $5,012Professionalmedian $98 · 10th to 90th $55 to $191
Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.
Rates by insurance carrier
| Insurance Carrier | Facility/Professional | Modifier | Typical Low | Median | Typical High |
|---|---|---|---|---|---|
Aetna Setting Facility Modifier None Typical Low $109.65 Median $3,548.13 Typical High $7,762.47 | Facility | None | $109.65 | $3,548.13 | $7,762.47 |
Aetna Setting Professional Modifier None Typical Low $60.26 Median $109.65 Typical High $173.78 | Professional | None | $60.26 | $109.65 | $173.78 |
Anthem BCBS Setting Facility Modifier None Typical Low $933.25 Median $3,162.28 Typical High $4,897.79 | Facility | None | $933.25 | $3,162.28 | $4,897.79 |
Anthem BCBS Setting Professional Modifier None Typical Low $85.11 Median $102.33 Typical High $173.78 | Professional | None | $85.11 | $102.33 | $173.78 |
CDPHP Setting Facility Modifier None Typical Low $1,348.96 Median $1,348.96 Typical High $4,073.80 | Facility | None | $1,348.96 | $1,348.96 | $4,073.80 |
CDPHP Setting Professional Modifier None Typical Low $72.44 Median $72.44 Typical High $138.04 | Professional | None | $72.44 | $72.44 | $138.04 |
Cigna Setting Facility Modifier None Typical Low $91.20 Median $177.83 Typical High $1,479.11 | Facility | None | $91.20 | $177.83 | $1,479.11 |
Cigna Setting Professional Modifier None Typical Low $44.67 Median $91.20 Typical High $323.59 | Professional | None | $44.67 | $91.20 | $323.59 |
Emblem Health Setting Facility Modifier None Typical Low $34.67 Median $56.23 Typical High $181.97 | Facility | None | $34.67 | $56.23 | $181.97 |
Emblem Health Setting Professional Modifier None Typical Low $120.23 Median $131.83 Typical High $204.17 | Professional | None | $120.23 | $131.83 | $204.17 |
Excellus BCBS Setting Professional Modifier None Typical Low $67.61 Median $97.72 Typical High $158.49 | Professional | None | $67.61 | $97.72 | $158.49 |
Highmark BCBS Setting Facility Modifier None Typical Low $50.12 Median $245.47 Typical High $1,202.26 | Facility | None | $50.12 | $245.47 | $1,202.26 |
MVP Health Care Setting Professional Modifier None Typical Low $46.77 Median $46.77 Typical High $245.47 | Professional | None | $46.77 | $46.77 | $245.47 |
United Setting Facility Modifier None Typical Low $363.08 Median $1,148.15 Typical High $4,365.16 | Facility | None | $363.08 | $1,148.15 | $4,365.16 |
United Setting Professional Modifier None Typical Low $42.66 Median $87.10 Typical High $223.87 | Professional | None | $42.66 | $87.10 | $223.87 |
Univera Setting Facility Modifier None Typical Low $43.65 Median $61.66 Typical High $213.80 | Facility | None | $43.65 | $61.66 | $213.80 |
Univera Setting Professional Modifier None Typical Low $66.07 Median $95.50 Typical High $154.88 | Professional | None | $66.07 | $95.50 | $154.88 |
14 more rates with less common billing modifiers
A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.
| Insurance Carrier | Facility/Professional | Modifier | Typical Low | Median | Typical High |
|---|---|---|---|---|---|
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $29.51 Median $50.12 Typical High $56.23 | Professional | 52 · Reduced service | $29.51 | $50.12 | $56.23 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $11.75 Median $19.95 Typical High $22.39 | Professional | 53 · Discontinued | $11.75 | $19.95 | $22.39 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $43.65 Median $74.13 Typical High $83.18 | Professional | 54 · Surgery only | $43.65 | $74.13 | $83.18 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $8.71 Median $14.79 Typical High $16.98 | Professional | 55 · Aftercare only | $8.71 | $14.79 | $16.98 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.89 Median $10.00 Typical High $11.22 | Professional | 56 · Pre-op care only | $5.89 | $10.00 | $11.22 |
Excellus BCBS Setting Professional Modifier 54 · Surgery only Typical Low $63.10 Median $120.23 Typical High $151.36 | Professional | 54 · Surgery only | $63.10 | $120.23 | $151.36 |
Excellus BCBS Setting Professional Modifier 55 · Aftercare only Typical Low $7.94 Median $14.79 Typical High $19.05 | Professional | 55 · Aftercare only | $7.94 | $14.79 | $19.05 |
Excellus BCBS Setting Professional Modifier 56 · Pre-op care only Typical Low $7.94 Median $14.79 Typical High $19.05 | Professional | 56 · Pre-op care only | $7.94 | $14.79 | $19.05 |
Excellus BCBS Setting Professional Modifier 78 · Unplanned return to OR Typical Low $63.10 Median $120.23 Typical High $151.36 | Professional | 78 · Unplanned return to OR | $63.10 | $120.23 | $151.36 |
MVP Health Care Setting Professional Modifier 53 · Discontinued Typical Low $47.86 Median $63.10 Typical High $97.72 | Professional | 53 · Discontinued | $47.86 | $63.10 | $97.72 |
Univera Setting Professional Modifier 54 · Surgery only Typical Low $52.48 Median $107.15 Typical High $151.36 | Professional | 54 · Surgery only | $52.48 | $107.15 | $151.36 |
Univera Setting Professional Modifier 55 · Aftercare only Typical Low $6.61 Median $13.49 Typical High $19.05 | Professional | 55 · Aftercare only | $6.61 | $13.49 | $19.05 |
Univera Setting Professional Modifier 56 · Pre-op care only Typical Low $6.61 Median $13.49 Typical High $19.05 | Professional | 56 · Pre-op care only | $6.61 | $13.49 | $19.05 |
Univera Setting Professional Modifier 78 · Unplanned return to OR Typical Low $52.48 Median $107.15 Typical High $151.36 | Professional | 78 · Unplanned return to OR | $52.48 | $107.15 | $151.36 |
Where New York sits
The same service costs 2.8 times more in Wisconsin than in Kentucky. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.
New York· 34th of 51
$102
WI $257KY $91.20
Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.